title: Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance-Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT).
abstract: BACKGROUND
  Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making.
  
  
  METHODS
  Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550).
  
  
  CONCLUSIONS
  MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.
  
  
  BACKGROUND
  Adjunctive study to IMPACT trial (Current Controlled Trials: ISRCTN83033550).
authors.affiliation: Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK. cindy.hagan@gmail.com.
authors.forename: Cindy C
authors.initials: CC
authors.lastname: Hagan
authors.forename: Julia Me
authors.initials: JM
authors.lastname: Graham
authors.forename: Barry
authors.initials: B
authors.lastname: Widmer
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Holt
authors.forename: Cinly
authors.initials: C
authors.lastname: Ooi
authors.forename: Adrienne O
authors.initials: AO
authors.lastname: van Nieuwenhuizen
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
authors.forename: Shirley
authors.initials: S
authors.lastname: Reynolds
authors.forename: Mary
authors.initials: M
authors.lastname: Target
authors.forename: Raphael
authors.initials: R
authors.lastname: Kelvin
authors.forename: Paul O
authors.initials: PO
authors.lastname: Wilkinson
authors.forename: Edward T
authors.initials: ET
authors.lastname: Bullmore
authors.forename: Belinda R
authors.initials: BR
authors.lastname: Lennox
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Sahakian
authors.forename: Ian
authors.initials: I
authors.lastname: Goodyer
authors.forename: John
authors.initials: J
authors.lastname: Suckling
mesh_terms: D000293:Adolescent; D000339:Affect; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012107:Research Design; D016896:Treatment Outcome